Has Academic Medicine Become A Socialist System And Might The Capitalism Of Big Pharma Be Bringing It Back?

By

Leonard Zwelling

https://www.nytimes.com/2019/12/05/opinion/socialism-capitalism.html

In David Brooks’ op-ed on December 6 in The New York Times he reveals a surprising fact about himself. In his youth, he was a socialist. As he is one of the few conservative writers on the Times’ editorial staff, this came as quite a shock.

In the rest of the piece, Mr. Brooks makes the case for capitalism as the savior of America, the West and the world in general. Why? Because the world is too complicated and fast-moving a place to have a planned economy led by a government. To get the most out of the resources of any society, human or otherwise, necessitates the forces of capitalism to get the most good to the most people. I believe that this is correct and is one of the reasons I am so troubled by the Democratic field of lefties like Bernie and Warren and old guys like Biden. I really don’t understand why Mayor Pete hasn’t caught on more than he has nor Cory Booker for that matter, but right now the top three are left, lefter, and leftest and all old. In fact they are all over 70. What’s with that? I’m over 70 and though I might be willing to go push-up to push-up with Joe Biden, I don’t want anyone in the Oval Office stupid enough to have his son on the payroll of a Ukrainian oil company when I am Vice President. This may not be a crime only because stupidity is not yet illegal. I’m not sure if it’s impeachable but Biden is no longer in office anyway. It was dumb and Joe needs to own up to that, which he has trouble doing. Why? Because he’s not the sharpest knife in the drawer and if you are a Biden backer, you might think about that. A debate between Biden and Trump might be waged in single syllable words with intermittent challenges to arm wrestle.

What the Brooks essay made me consider was whether or not academic medicine has fallen victim to socialism as the Dems seem to have.

First, what’s the greatest source of support for research? The NIH. That’s a government agency determining the size of the nation’s research budget. Oh sure, there are many non-profits supporting research but none has the billions that the NIH devotes to research and few have the combined power of the National Science Foundation and the NIH for supporting basic research, the stuff on which drug companies and Nobel Prizes are built.

In fact, it may be the drug companies that are trying to undo the socialistic monopoly held by the NIH. Big Pharma funds what it is interested in and that interest is as competitive and capitalistic as you can get. Without the drug companies, clinical research would never get done and today one might actually be able to get tenure by building an academic research career on private money. A basic scientist can’t, but a clinical scientist can.

My point is only that for many years, the gold standard of academic excellence was the RO1 federal grant. These have become harder and harder to procure and the age at which a faculty member gets his or her first RO1 is advancing into the forties.

But if you think about the NIH funding stream as a socialist program that may or may not be merit based (grantsmanship being what it is and the value of friends in the system incalculable), perhaps we should be more welcoming of the money coming from the pharmaceutical industry as being truly capitalistic.

There’s all kinds of socialism and all kinds of capitalism, but in general the latter tends to triumph over the former. Perhaps we need more capitalism in academia. I’m for that if the conflicts of interest can be eliminated such that no professors are getting rich from what they do in their university labs. Of course, the real way to take advantage of capitalism is to do the research for the companies to start with which won’t help academia at all. Somehow there has to be a way to balance innovation and conflict of interest in academic medicine. It might be as simple as eliminating cash payments or stock ownership from the portfolios of academics and make sure all of the money coming from Big Pharma goes to the institution for the research. That means the institution cannot own drug stocks either. But a down side consequence may be the desertion of academics to industry as I do believe that is where the smart money is going.

Use RO1s to get promoted and do pharma research on the side while taking no cash from industry. Commercialize what you do in the lab and then, if you must, go over to the dark side. Who said you cannot be an ex-professor and be wealthy, too? It can be done. One just shouldn’t be on the payroll of a drug company and a university simultaneously.